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Prognostic factors in infants with acute myeloid leukemia
C H Pui1, S C Raimondi, D K Srivastava
1Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
Insights
Prognostic factors for acute myeloid leukemia (AML) in young children were analyzed. FAB M4/M5 leukemia and the t(9;11) translocation are favorable indicators in children 24 months or younger.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Genetics
Background:
- Treatment outcomes for acute myeloid leukemia (AML) in very young children are not well understood.
- Identifying prognostic factors is crucial for tailoring treatment strategies in pediatric AML.
Purpose of the Study:
- To analyze the prognostic impact of clinical and laboratory features in distinct age groups of children with AML.
- To compare presenting features and treatment outcomes between infants/toddlers (≤24 months) and older children (>24 months).
Main Methods:
- Retrospective analysis of 299 children with AML treated across four clinical trials (1980-1997).
- Patients were categorized into age groups: ≤12 months, 13-24 months, and >24 months.
- Statistical analysis was performed to identify independent prognostic factors for favorable outcomes.
Main Results:
- Children ≤24 months (n=56) showed similar outcomes and distinct presenting features compared to older children (n=243).
- Younger children were more likely to have FAB M4/M5 leukemia, CNS leukemia, and 11q23 translocations (including t(9;11)), but less likely to have Auer rods or t(8;21).
- For patients ≤24 months, FAB M4/M5 leukemia and t(9;11) were independently associated with a favorable prognosis. For older patients, low leukocyte count and t(9;11) were favorable.
Conclusions:
- Age is a significant factor influencing presenting characteristics and prognosis in pediatric AML.
- Specific genetic markers (FAB M4/M5, t(9;11)) hold prognostic value in infants and toddlers with AML.
- Further research into age-specific prognostic markers can optimize treatment for pediatric AML.
Abstract:
Little is known about the factors that affect treatment outcome in very young children with acute myeloid leukemia (AML). We therefore analyzed the prognostic impact of various presenting clinical and laboratory features by discrete age group in 299 children with AML treated in four consecutive clinical trials between 1980 and 1997. Differences in presenting features, as well as treatment outcome, were compared between children aged 12 months or less (n = 28) or 13 to 24 months (n = 28) and those more than 24 months of age (n = 243). Children in the two youngest groups (24 months of age or less) had similar presenting features and treatment outcome. Collectively, these 56 children were significantly more likely than the 243 older patients to have M4 or M5 leukemia (70% vs 30%), CNS leukemia (33% vs 22%), the t(9;11) (p22;q23) (18% vs 6%) or other 11q23 translocations (23% vs 3%), and less likely to have Auer rods (2% vs 54%) or the t(8;21) (q22;q22) (0% vs 17%). Among patients aged 24 months or less, two factors independently predicted a favorable prognosis: FAB M4 or M5 leukemia (relative risk of relapse, 0.4; 95% confidence interval, 0.2-0.9) and the t(9;11) (relative risk, 0.3; 95% confidence interval, 0.1-1.0). Leukocyte count and 11q23 translocations other than the t(9;11) lacked prognostic significance. Among older patients, a leukocyte count <50 x 10(9)/l and the presence of the t(9;11) conferred a favorable prognosis.